Empire mediblue healthplus

Empire mediblue healthplus DEFAULT

2022 Medicare Advantage Plan Benefit Details for the Empire MediBlue HealthPlus (HMO)

— Plan Health Benefits —** Base Plan ** Premium• Health plan premium: $0 • Drug plan premium: $25 • You must continue to pay your Part B premium.• Part B premium reduction: NoDeductible• Health plan deductible: $0 • Other health plan deductibles: In-network: No • Drug plan deductible: $200.00 annual deductibleMaximum out-of-pocket enrollee responsibility (does not include prescription drugs)• $5 Optional supplemental benefits• No Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?• In-network: No Doctor visits• Primary: $5 copay per visit • Specialist: $40 copay per visit (authorization and referral required) Diagnostic procedures/lab services/imaging• Diagnostic tests and procedures: $0-150 copay (authorization and referral required) • Lab services: $0 copay (authorization and referral required) • Diagnostic radiology services (e.g., MRI): $95-175 copay (authorization and referral required) • Outpatient x-rays: $30-80 copay (authorization and referral required) Emergency care/Urgent care• Emergency: $90 copay per visit (always covered) • Urgent care: $65 copay per visit (always covered) Inpatient hospital coverage• $385 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) Outpatient hospital coverage• $0-350 copay per visit (authorization and referral required) Skilled Nursing Facility• $0 per day for days 1 through 20
$188 per day for days 21 through 100 (authorization required) Preventive care• $0 copay Ground ambulance• $300 copay Rehabilitation services• Occupational therapy visit: $40 copay (authorization and referral required) • Physical therapy and speech and language therapy visit: $40 copay (authorization and referral required) Mental health services• Inpatient hospital - psychiatric: $415 per day for days 1 through 4
$0 per day for days 5 through 90 (authorization required) • Outpatient group therapy visit with a psychiatrist: $40 copay (authorization and referral required) • Outpatient individual therapy visit with a psychiatrist: $40 copay (authorization and referral required) • Outpatient group therapy visit: $40 copay (authorization and referral required) • Outpatient individual therapy visit: $40 copay (authorization and referral required) Opioid treatment program services• In-network: $40.00 copay (authorization and referral required) Medical equipment/supplies• Durable medical equipment (e.g., wheelchairs, oxygen): 0-20% coinsurance per item (authorization required) • Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required) • Diabetes supplies: $0 copay Dialysis• 20% coinsurance Hearing• Hearing exam: $40 copay (authorization and referral required) • Fitting/evaluation: $0 copay (limits apply, authorization and referral required) • Hearing aids: $0 copay (limits apply, authorization required) Preventive dental• Oral exam: $0 copay (limits apply) • Cleaning: $0 copay (limits apply) • Fluoride treatment: Not covered• Dental x-ray(s): $0 copay (limits apply) Comprehensive dental• Non-routine services: $0 copay (limits apply, authorization required) • Diagnostic services: $0 copay (limits apply, authorization required) • Restorative services: $0 copay (limits apply, authorization required) • Endodontics: $0 copay (limits apply, authorization required) • Periodontics: $0 copay (limits apply, authorization required) • Extractions: $0 copay (limits apply, authorization required) • Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply, authorization required) Vision• Routine eye exam: $0 copay (limits apply) • Other: Not covered• Contact lenses: $0 copay (limits apply) • Eyeglasses (frames and lenses): $0 copay (limits apply) • Eyeglass frames: $0 copay (limits apply) • Eyeglass lenses: $0 copay (limits apply) • Upgrades: Not coveredMedically-approved non-opioid pain management services• Chiropractic services: Not covered• Acupuncture: Not covered• Therapeutic Massage: Not covered• Alternative Therapies: Not coveredMore benefits• Over-the-counter drug benefits: Some coverage• Meals for short duration: Some coverage• Annual physical exams: Some coverage• Telehealth: Some coverage• WorldWide emergency transportation: Some coverage• WorldWide emergency coverage: Some coverage• WorldWide emergency urgent care: Some coverage• Fitness Benefit: Some coverage• In-Home Support Services: Not covered• Bathroom Safety Devices: Not covered• Health Education: Not covered• In-Home Safety Assessment: Not covered• Personal Emergency Response System (PERS): Some coverage• Medical Nutrition Therapy (MNT): Not covered• Post discharge In-Home Medication Reconciliation: Not covered• Re-admission Prevention: Not covered• Wigs for Hair Loss Related to Chemotherapy: Not covered• Weight Management Programs: Not covered• Adult Day Health Services: Not covered• Nutritional/Dietary Benefit: Not covered• Home-Based Palliative Care: Not covered• Support for Caregivers of Enrollees: Not covered• Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered• Enhanced Disease Management: Not covered• Telemonitoring Services: Not covered• Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Some coverage• Counseling Services: Not coveredWellness programs (e.g., fitness, nursing hotline)• Covered (authorization required) Transportation• Not coveredFoot care (podiatry services)• Foot exams and treatment: $40 copay (authorization and referral required) • Routine foot care: Not coveredMedicare Part B drugs• Chemotherapy: 20% coinsurance (authorization required) • Other Part B drugs: 20% coinsurance (authorization required)
Sours: https://q1medicare.com/MedicareAdvantage-PartC-MedicareHealthPlanBenefits.php?source=2021MARxFinder&countyCode=36087&state=NY&contractId=H1732&planId=005&segmentId=0&plan=Empire%20MediBlue%20HealthPlus%20(HMO)&utm_source=partd&utm_medium=rxfinder&utm_campaign=planname

Empire BlueCross’ Medicare Advantage Plans in New York Receive 4-Star Rating from CMS

Albany – Empire BlueCross (Empire) today announced that heading into next year, Empire’s 2018 Medicare Advantage HMO plans will be rated four stars – with five stars being the best rating – by the Medicare Star Ratings program issued by the Centers for Medicare & Medicaid Services (CMS). Empire offers these plans in 15 counties throughout New York. Last week, the CMS released their latest Star Ratings, which gives health plans scores for the quality and performance of their services.

“Empire’s continued commitment to giving our members access to high-quality, affordable health care is one of the main reasons our plans achieved high Star Ratings this year,” said Tomas Orozco, president of the company’s Medicare east region. “We are grateful for our network of providers who collaborate with us to ensure that we’re delivering the quality and performance members expect from their health plan. We will continue to partner with our members to ensure we are providing them with the benefits they want, in order to meet their health care and lifestyle needs.”

  • Empire MediBlue Plus (HMO), Empire MediBlue Select (HMO), Empire MediBlue Core (HMO), Empire MediBlue Choice (HMO-POS), and Empire MediBlue Dual Advantage (HMO SNP) received four stars from CMS.
  • Empire MediBlue Plus (HMO) is available in Albany, Bronx, Kings, Nassau, New York, Queens, Rensselaer, Saratoga, and Schenectady counties.
  • Empire MediBlue Select (HMO) is available in Dutchess, Orange, and Putnam counties.
  • Empire MediBlue Core (HMO) is available in Bronx, Kings, Queens, Richmond, Saratoga, and Westchester counties.
  • Empire MediBlue Choice (HMO-POS) is available in Kings and Nassau counties.
  • Empire MediBlue Dual Advantage (HMO SNP) is in available Albany, Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Schenectady, and Westchester counties.

“We are pleased that CMS has recognized our efforts to improve the health outcomes and experiences of our current plan members and those we hope to have the privilege of serving in the future,” Orozco added.

The CMS’ Medicare Star Rating system rates the quality and performance of Medicare Advantage plans to help consumers and their families compare plans. Medicare Advantage plans are rated on their ability to:

  • Help members stay healthy
  • Assist members in managing chronic conditions
  • Ensure positive member experiences with their health plan
  • Achieve member satisfaction
  • Provide effective customer service

Additionally, Medicare Advantage and Medicare Prescription Drug Plans are rated on how well they provide medication coverage along a number of factors: customer service, member complaints, member experience with drug plan, and drug safety.

Star Ratings are calculated each year using a scale of one to five stars, and may change from year to year. The annual Medicare Star Ratings are posted online at www.medicare.gov.

Consumers can enroll in Empire’s 2018 Medicare Advantage plans during Medicare’s Annual Election Period (AEP), which begins October 15, 2017 and continues through December 7, 2017. Plans purchased during AEP are effective January 1, 2018. For details about Empire’s Medicare plans in your area, call (855) 866-4242 or visit Empire’s Medicare online store at https://shop.empireblue.com/medicare.

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Empire BlueCross is an HMO plan with a Medicare contract. Empire BlueCross is an HMO DSNP plan with a Medicare contract and a coordination of benefits agreement with the New York Medicaid program. Empire BlueCross is an LPPO plan with a Medicare contract. Enrollment in Empire BlueCross depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. We do not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability in our health programs and activities. 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-888-230-7338(TTY:711)。 ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-230-7338 (TTY: 711). This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Other providers are available in our network. The provider network may change at any time. You will receive notice when necessary.

About Empire BlueCross
Empire BlueCross (Empire) is the trade name of Empire HealthChoice Assurance, Inc. and Empire BlueCross HMO is the trade name of Empire HealthChoice HMO, Inc. independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/EmpireBCBS_News and on Facebook at www.facebook.com/AskEmpire.

Sours: https://www.bcbs.com/news/press-releases/empire-bluecross-medicare-advantage-plans-new-york-receive-4-star-rating-cms
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Empire Blue Cross Blue Shield / Empire Health Plus (JLJ)

NY Allergy & Sinus Centers accepts Empire Blue Cross Blue Shield / Empire Health Plus (JLJ). If you have JLJ on your member ID card, you are enrolled in Empire Blue Cross Blue Shield Health Plus. It is your responsibility to know your benefits and coverage.

The information we receive may not always have the most accurate and updated benefit coverage. It may be helpful for you to contact your insurance provider’s member services department before coming to see the physician. Know what your individual plan covers before you visit NY Allergy & Sinus Centers.

Contact Empire Health Plus Member Services at 800-450-8753 or by calling the number on the back of your insurance card to verify your benefits and coverage.

What to Ask:

Explain to the representative that you are planning to visit a specialist at NY Allergy & Sinus Centers. 

1. Confirm that we are in-network with your insurance plan.

2. Ask about coverage for:

  • An office visit with a specialist allergist
  • Allergy testing performed in the office
  • Allergy injections and other treatment
  • CT scans
  • Contracted prices for the above services (only if you have a deductible)
  • Prescription coverage

If services are subject to your deductible you may want to request prices for such services.

Be sure to provide our call service agents your insurance identification number and plan when booking an appointment. Also, remember to bring your insurance card to your appointment. Know your policy holder’s name and date of birth in addition to our practice name and the office address in which you are visiting.

For any questions regarding your office visit and insurance, please call us at (212) 686-4448.

Sours: https://www.nyallergy.com/empire-blue-cross-blue-shield-empire-health-plus-jlj/



The Empire app helps you make healthy happen, wherever you go.

This app is for plan members in Medicaid Managed Care, Child Health Plus and Essential Plan.

With the Empire mobile app, you can:

Log in easily and securely with Touch ID/Face ID.
Find a doctor, hospital, pharmacy or specialist that serves your plan. You can search by city and state, specialty and plan.
Always have your member ID card with you to view.
Find a Community Service Center near you.
Get important notices about your benefits
Check your symptoms with our symptom checker.
Call a registered nurse (RN) to talk in private about your health anytime, day or night.
Manage your prescriptions. Order refills, track your shipments and view your pharmacy claims (if applicable to your plan).

Version 6.3.0

[+] We’ve added extra features to the New York Empire app for our members
[+] We’ve added live chat capability for members to the New York Empire app
[+] Improvements in overall stability of the app

Ratings and Reviews

No point downloading this app

If you call after hours it instructs you to download and use the app or call back the next day. But if you download the app it LITERALLY does not allow you to log in. There is no point in downloading this app.

What’s the point of this app?

I’ve been trying to access this app for months now. And it never works. What’s the point of it if I’m never going to be able to log in to view my plan? Don’t download, waste of time.

Doesn’t recognize your member ID

Sooo, pretty useless. Why do they continue to advertise this app on the site when it seems I’m not alone here in not being able to log in.

The developer, Anthem, Inc, indicated that the app’s privacy practices may include handling of data as described below. For more information, see the developer’s privacy policy.

Data Not Linked to You

The following data may be collected but it is not linked to your identity:

Privacy practices may vary, for example, based on the features you use or your age. Learn More


Anthem, Inc

55.7 MB


Requires iOS 11.0 or later.
Requires iPadOS 11.0 or later.
iPod touch
Requires iOS 11.0 or later.
Requires macOS 11.0 or later and a Mac with Apple M1 chip.

Age Rating

© 2018 HealthPlus HP, LLC



  • Family Sharing

    With Family Sharing set up, up to six family members can use this app.

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Sours: https://apps.apple.com/us/app/empire-healthplus/id1414438040

Healthplus empire mediblue

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Renew your benefits with Empire BlueCross HealthPlus

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